Breast and Cervical Cancer Screening Depends on Age and Level of Risk

Over the past 15 years, there’s been a decline among women ages 50 and older in deaths from breast cancer— but it’s still the second leading cause of cancer death in women, according to the American Cancer Society (ACS). And while the risk of developing cervical cancer is still present as women age, this condition rarely occurs in women who have been getting regular tests to screen for cervical cancer before they were 65, also according to the ACS.

This leads to the question: Who should undergo screening for breast and cervical cancer, and how often should they be screened? Screening recommendations are changing, as more is learned about what causes these cancers, as new screening methods are developed, and as more information emerges about the benefits and risks of screenings.

“For many years, mammogram recommendations took a ‘one size fits all’ approach, with annual mammograms starting at age 40. The downside to this kind of universal screening is that women at increased risk may be underscreened and women who are at low or average risk may be over-screened,” says Margaret Polaneczky, MD, a gynecologist at Weill Cornell Medicine. “While some organizations continue to recommend universal screening starting at age 40, others take into account an individual’s breast cancer risk and balance the benefits of mammograms with the harms, such as false positives and overdiagnosis,” she explains.

By detecting breast cancer at an early stage, mammograms allow for early treatment that can increase the chance of a cure. However, as Dr. Polaneczky points out, mammograms miss about one in eight breast cancers and can lead to overdiagnosis and overtreatment by diagnosing some conditions that never cause symptoms or lead to death.

Mammogram Recommendations

For women over 50, mammograms are recommended either annually or every other year, depending on your risk and concerns. Keep in mind that the more often you have mammography, the higher the chance of a false positive.

Dr. Polaneczky suggests that the decision about when to start and how often to have mammograms is best made on an individual basis, based on your risk for breast cancer. After age 75, she says, it’s worth discussing with your doctor both the risks and benefits of continued screening, taking into account your overall health and your risk level.

Cervical Cancer Screening

Pap smear screening recommendations also have changed since the link between cervical cancer and infection with humanpapilloma virus (HPV) has been established. Research shows that HPV is the primary cause of virtually all cases of cervical cancer. Over the years, cervical cancer screening has evolved from the original Papanicolau test to one that now incorporates HPV testing either as primary screening or in conjunction with the Pap smear.

Generally, it is recommended that women ages 50 and over get a Pap test every three years if they have had normal Pap test results for three years in a row with no history of precancerous results. Or they can screen using HPV testing, alone or in conjunction with the Pap, every fve years. Dr. Polaneczky says after age 65, women can stop cervical cancer screening if they do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and have had either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years.

The False Positive Problem

The problem with many screening tests is the sensitivity-to-specificity ratio, which means: Will the test produce too many false positives in people who don’t have the disease, and how precise is the test in identifying disease that does exist? “Any suspicion of cancer means that follow- up tests, which may include additional screening and/or a biopsy will be needed,” says Dr. Polaneczky, “but that is the price we pay for finding the curable early cancers.”

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